Of 209 pregnancy-related deaths in California during the period 2002-2005, Afshan B. Hameed, MD, associate professor of clinical cardiology, obstetrics and gynecology at the University of California, Irvine, and colleagues found that 54 of these women died from cardiovascular complications – and 35 of those were caused by cardiomyopathy.

About 30% of the deaths could have been prevented had these women, who showed persistent signs of distress, been treated appropriately, Hameed said at a press briefing at the annual meeting of the American Heart Association.

"Most cardiovascular disease was not diagnosed until after the women gave birth or had died," Hameed said. "Early recognition of a symptomatic patient and referral to a cardiologist by obstetrics providers may help prevent serious morbidity and mortality."

The researchers scrutinized records of 2,147,492 live births in California. In that group, 732 women died while pregnant or within a year after the pregnancy, and 209 were determined to be pregnancy-related deaths, Hameed said.

After performing statistical analyses, the researchers determined that "less than a quarter of women had their cardiovascular disease diagnosed before giving birth" -- 6% were known to have had a pre-existing cardiovascular condition prior to pregnancy, 8% had their condition diagnosed prenatally, and another 8% were determined to have cardiovascular complications during labor and delivery.

Hameed said 37% of the women who died had their conditions diagnosed in the postpartum period – and 41% had their condition diagnosed at autopsy.

Among the women who died of cardiomyopathy, the researchers found that they were more than four times more likely to have used illicit drugs than women who died of noncardiovascular reasons (P<0.001). They were also more likely to be African-American – 43% of those with cardiomyopathy were black compared with 17% of those who died from noncardiovascular events (P<0.01). The women who died of cardiomyopathy were also more likely to be obese (49% versus 23%, P<0.01).

Half the women who died of cardiomyopathy were younger than 30; another 15% were younger than 35 years.

"Medical care professionals and public health should support efforts that help women achieve a healthy weight and avoid substance abuse because of the increased risk of cardiovascular complications in pregnancy," Hameed said.

In commenting on the study for the American Heart Association, Michael Gewitz, MD, chief of pediatric cardiology at Westchester Medical Center and New York Medical College in Valhalla, N.Y., told MedPage Today:

"This study showed that in a significant portion of these women unrecognized cardiovascular problems, in particular cardiomyopathy, was the cause of their deaths in the late stages of pregnancy and childbirth.

"The researchers found that many of the women expressed symptoms commonly attributed to pregnancy: Shortness of breath, palpitations, fatigue, and anxiety. However persistence of these symptoms, a typical presentation of the symptoms, duration of the symptoms were markers that may have alerted physicians or other providers who were caring for these women as to the underlying problem."

Gewitz suggested that interventions could have changed many of the outcomes including such things as "closer monitoring during pregnancy, measuring oxygen levels in the blood, adding diuretics at appropriate times, and other relatively simple things may have had a sizable impact."

He said doctors need to remember that women can present with serious heart problem with symptoms that are otherwise not recognized as relating to the heart problem. "And that certainly is true in pregnancy as well," he said. "Physicians and other providers who take care of women who are at risk, and in this population in the study African-American women seemed to be at higher risk and these women need to be paid attention to when they have symptoms that otherwise might be attributed to routine pregnancy condition."

Hameed and Gewitz had no disclosures.

Reviewed by Zalman S. Agus, MD Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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